Parathyroid Surgery

The parathyroid glands are the size of a rice grain and sit around the butterfly shaped thyroid gland. There are usually 4 parathyroid glands. They secrete a hormone called PTH, which acts on many organs including the stomach, bones, and kidneys to increase the blood level of calcium. If you have been referred for consideration for parathyroid surgery by your doctor, it may be because they have found a high calcium level in your blood.

Professor Sidhu will offer a key hole operation where possible. The majority of patients can have a keyhole operation. The neck incision for this is 2-2.5cm. Prior to surgery, where appropriate, you may have a sestamibi scan, ultrasound and/or CT scan to localise the abnormal gland producing your high calcium. If localisation is possible this increases the probability of being able to have a key hole procedure.

If the abnormal gland can not be localised prior to surgey Professor Sidhu may undertake a four gland exploration. The incision for this procedure will be approximately 5cm.

Professor Sidhu will make the incision in an existing crease within the neck wherever possible.

Post-operative care of the wound will assist to reduce the visibility of scarring. Following surgery the wound will be stitched with dissolvable stitches, it will be covered with surgical tape. If the surgical tape comes off before your post-operative review it can be replaced with micropore tape which is available at most pharamcies.

Everyone is naturally worried about having their throat cut through parathyroid surgery. It is not possible for a parathyroid surgeon to give a patient a guarantee of no complications. However, after having performed over 5,000 operations on the neck, patients can be reassured that risks of problems occurring are small and when they do occur Professor Sidhu has the expertise to manage them.

Parathyroid glands are the small glands located in the neck behind the thyroid gland. These glands regulate the amount of calcium in the body including the amount of calcium in the blood as well as in the bones.

The main reason for requiring parathyroid surgery is when you are diagnosed with primary hyperparathyroidism, which is often caused by a non-cancerous growth in one of the four parathyroid glands. The abnormal growth produces excessive parathyroid (PTH), which often leads to high levels of PTH and calcium in the blood.

You can also develop hyperparathyroidism if you are on dialysis because of kidney failure. This is known as secondary hyperparathyroidism, as the parathyroid glands could be enlarged as a complication of kidney failure. This case requires parathyroid surgery to control the high levels of PTH in the blood.

If you are having an operation in the public hospital, the hospital will contact you about 1 month prior to surgery and ask you to attend for a preoperative assessment by the hospital anaesthetic team. The hospital will notify you of the time to arrive on the day of your operation.

In the private hospital setting, your date will be allocated at the time of consultation or soon thereafter and you will be seen by your private anaesthetist prior to or on the day of surgery. The private hospital will notify you, the day prior to surgery, of the time to arrive on the day of your operation.

Do I need to fast?

Yes, you do. Patients having morning surgery need to be fasted from 12 midnight and patients having afternoon surgery are permitted to have a light breakfast and fast from 0700 hours.

Medications

All patients taking a tablet that causes bleeding must stop the tablets prior to surgery.
This includes the following medications:

Aspirin – 2 weeks

Plavix or Iscover – 2 weeks

Warfarin – 5 days

Herbal medications eg St John’s Wort – 2 weeks

Factor X inhibitor eg Xarelto 3 days

Professor Sidhu will discuss these medications at the time of consultation.

Neck exercises

To gain access to the parathyroid glands the neck is tilted backwards. To help relieve soreness and swelling we recommend neck exercises prior to the surgery. Neck exercises booklet can be found here.

Your parathyroid surgery is undertaken using a general anaesthetic: you will be asleep for the operation. Local anaesthetic is used in the neck area to numb the skin for 12-16 hours after surgery. The anaesthetic tube used during surgery can sometimes cause a sore throat afterwards. You will be given tablets for pain relief afterwards. Sometimes by having the neck extended during parathyroid surgery, patients complain of pain in the back of their neck or head- neck exercises and physiotherapy do help in alleviating this pain.

You will wake up with an ice pack on your neck to be used for the first 12-24 hours to minimize skin swelling.

The hospital stay is usually for 1 or 2 nights. Most patients having parathyroids removed will stay 1 night.

All patients will be given a sheet to explain what to expect following the parathyroid surgery . If this does not happen, please download here.

The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days. You can shower as normal. Following 10 days, the steristrip is replaced with a brown micropore tape. This can be changed every 2 days with the use of BIO Oil in between dressing changes. The use of the steristrip for 6 weeks post parathyroid surgery minimises scar stretching.

No driving is permitted for 3-4 days following the parathyroid surgery and you can return to work in 1-2 weeks depending on the type of work you do.

A number of symptoms can occur following parathyroid surgery , which you don’t have to worry about. These are normal and will settle with time. They include:

Sensation of difficulty swallowing

Sensation of tightness in the neck without any obvious neck swelling

Numbness in the skin above and below the incision

Throat irritation from the anaesthetic tube

Intermittent voice change. This can range from true hoarseness of voice all the time to fluctuations in volume and clarity especially towards the end of the day.

Recurrent laryngeal nerve injury is usually temporary in 2-3% of people and recovers in a few weeks following surgery.

Tingling in the fingers and toes with cramping in the hands and feet. This is due to a low calcium level. You will be sent home on calcium tablets following a total thyroidectomy to minimize the chance of this happening. Please see post-operative instructions.

If any of these symptoms occur after your thyroid surgery, please contact Professor Sidhu on his mobile (provided on his business card) and the postoperative instruction sheet or go to your local hospital if you are are country patient.

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About Professor Sidhu

Professor Stan Sidhu is Professor of Surgery and Head of the University of Sydney Endocrine Surgical Unit.

He is a thyroid specialist and an academic endocrine surgeon practicing within the Northern Sydney and Central Coast Area Health Service. He is also The Professor of the University of Sydney Endocrine Surgical Unit.